Vaginal Progesterone to Prevent Preterm Birth in Twins

PURPOSE:

This study by Romero et al. (Ultrasound in Obstetrics and Gynecology, 2017) sought to determine if vaginal progesterone could prevent the preterm birth and newborn morbidity and mortality in an otherwise asymptomatic twin gestation with a mid-trimester sonographic short cervix (≤ 25mm).

METHODS:

Systematic Review and Meta-Analysis

RESULTS:

303 women were included from 6 RCTs with 159 given vaginal progesterone. Vaginal progesterone significantly decreased the risk of preterm birth at < 33 weeks by approximately a third (31%). There was no difference in preterm birth at <37, <36 and <28 weeks. Neonatal death, composite neonatal morbidity and mortality, respiratory distress syndrome, use of mechanical ventilation, and low birth weight were also reduced. The authors downgraded the quality of these findings from high to moderate quality due to potential biases. In addition, dosing and route of medication delivery were not all the same in the various studies. Therefore, the authors acknowledge that future studies may challenge these findings. Of note, no neurodevelopmental differences were seen at ages 4-5 years between the two groups. Nor were there any differences in maternal adverse events demonstrated in this study.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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